Form 39nr - Idaho Supplemental Schedule - 2016 Page 2

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Form 39NR - 2016
Page 2
EFO00087p2 08-01-2016
Name(s) as shown on return
Social Security number
C. Credit for Income Tax Paid to Other States by Part-Year Residents. See instructions, page 32.
.
Nonresidents can't claim this credit. Idaho residents on active military duty, complete Part D below.
This credit is being claimed for taxes paid to: __________________________________
(State name)
1 Idaho adjusted income from Form 43, line 31, Column B ........................
1
00
.
2. Federal adjusted gross income earned in other state adjusted for
Include a copy of the
.
Idaho modifications. See instructions ......................................................
income tax return and
2
00
a separate Form 39NR
3. Amount of income taxed by Idaho, and also taxed by another state ........
3
00
for each state for which
4. Idaho tax, Form 43, line 42 .......................................................................
a credit is claimed.
4
00
5. Divide line 3 by line 1. Enter percentage here .........................................
%
5
.
6. Multiply line 4 by line 5 ....................................................................................................................
6
00
7. Other state's tax due less its income tax credits ......................................
7
00
8. Divide line 3 by line 2. Enter percentage here ..........................................
8
%
9. Multiply line 7 by line 8 ...................................................................................................................
9
00
10. Enter the smaller of line 6 or 9 here and on Form 43, line 43 .........................................................
10
00
D. Credit for Income Tax Paid to Other States by Idaho Residents on Active Military Duty.
See instructions, page 33.
This credit is being claimed for taxes paid to: __________________________________
(State name)
.
1. Idaho tax, Form 43, line 42 .......................................................................
Include a copy of the
1
00
income tax return and
2. Other state's adjusted income. See instructions .....................................
2
00
a separate Form 39NR
3. Idaho adjusted income from Form 43, line 31, Column B ........................
for each state for which
3
00
4. Divide line 2 by line 3. Enter percentage here ..........................................
a credit is claimed.
4
%
.
5. Multiply line 1 by line 4. Enter amount here ...................................................................................
5
00
.
6. Other state's tax due less its income tax credits ............................................................................
6
00
7. Enter the smaller of line 5 or 6 here and on Form 43, line 43 ........................................................
7
00
E. Credits for Idaho Educational Entity and Idaho Youth and Rehabilitation
.
Facility Contributions and Live Organ Donation Expenses. See instructions, page 33.
. .
1. Credit for contributions to Idaho educational entities ......................................................................
1
00
2. Credit for contributions to Idaho youth and rehabilitation facilities ..................................................
2
00
3. Credit for live organ donation expenses .........................................................................................
3
00
4. Total credits. Add lines 1 through 3. Enter total here and on Form 43, line 44 .............................
4
00
F. Maintaining a Home for a Family Member Age 65 or Older, or a Family Member With a
Developmental Disability. See instructions, page 34.
1. Did you maintain a home for an immediate family member age 65 or older and provide more than
No
Yes
one-half of his/her support? You and your spouse don't qualify ....................................................
2. Did you maintain a home for an immediate family member with a developmental disability and
No
Yes
provide more than one-half of his/her support? You and your spouse may qualify .......................
3. List each family member you're claiming:
Check Here if
Date of Birth of
Social Security Number
Relationship to Person
Name of Family Member
Developmentally
Family Member
First Name
Last Name
of Family Member
Filing Return
Disabled
4. Total amount claimed ($100 for each qualifying member but not more than $300).
Enter here and on Form 43, line 63. (Credit can't be claimed if you took $1,000 deduction
on Part B, line 11.) ...................................................................................................................
4
00
G. Dependents: (Continued from Form 43, page 1, Line 6c)
Social Security Number
First Name
Last Name

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